Kristine Slam, MD, FACP, discusses the importance of genetic testing in male patients with breast cancer and why it’s important that all patients with breast cancer advocate for themselves.
Kristine Slam, MD, FACP, Central Ohio Surgical Associates, discusses why treatment for breast cancer in male patients echoes that provided to female patients, the importance of genetic testing in male patients, and why it’s important that all patients with breast cancer advocate for themselves.
"One of the most important things is for patients to understand what their options are," Slam notes. "As a doc, if I don't have a patient asking a lot of questions, I wonder if they're truly listening and comprehending. I expect a lot of questions, I want questions."
Can you explain why male breast cancer is so rare and how treatment protocols differ from those for female patients?
Breast cancer is much less common in male patients because in general breast cancer is a function of increasing age, gender, bad luck, and just exogenous estrogen. We make estrogens in our ovaries in our subcutaneous tissue. Obviously, men don't have ovaries, and so that's part of the reason it is much less common. Breast cancer in men, if they end up developing breast cancer, is an immediate indication for genetic testing; there is much more of a hereditary component of a male develops breast cancer. So that's one of the treatment differences is they routinely will undergo genetic testing for BRCA1 and 2 mutations. In general, however, breast cancer in men is still diagnosed at a later stage because they don't believe it can happen. If we do catch it early and they are cognizant of whatnot, we can catch it at an early stage. We have not, as a society, done a lot of studies in breast cancer in male patients so we really do follow the female treatment protocols.
It's still such an uncommon condition. Most of the education, most of the trials, are still based on females. And we just extrapolate the data for male patients. A lot of the trials, when trials need to be developed, need to have a strong number of patients in order for therapies to be validated. And just the n is so small to start with, the outcomes are going to be hard to extrapolate.
What advice would you like to offer patients?
I think one of the most important things for patients is understanding what their options are. I think a lot of patients still do not advocate strongly enough for themselves. Whether it is, “I still have questions about my treatment, please reexplain this” or “I have questions about my financial costs and long-term side effects.” I really encourage patients to not be scared to ask these questions. As a doc, I may not know all the answers. I have to rely on my treatment team, my social workers, my nurse navigators to help get them the answers they need. But I would just strongly encourage patients to advocate for themselves.
Ask away. As a doc, if I don't have a patient asking a lot of questions, I wonder if they're truly listening and comprehending. I expect a lot of questions, I want questions. So that's good.